When Dr. Smith and Bill Wilson started Alcoholics Anonymous (AA) back in 1935, no one anticipated it would turn into the juggernaut it eventually became. AA threw struggling alcoholics a lifeline, and over the past 80 years tens of millions have grabbed it and held on for dear life. But are 12-Step programs like AA really effective against alcoholism?
Dr. Lance Dodes, a psychiatrist who specializes in treatment for substance abuse, claims most emphatically that they are not. His critique appeared in written form in 2014, in a book he co-authored with his son, freelance writer Zachary Dodes, called The Sober Truth: Debunking the Bad Science Behind 12-Step Programs And The Rehab Industry. No One Likes the Popular Kids AA has become so popular and well-known that courts frequently mandate attendance at its meetings for people convicted of driving under the influence or other crimes related to alcohol. Numerous spin- off versions of AA’s 12-Step program have popped up over the years (Narcotics Anonymous, Gamblers Anonymous, Overeaters Anonymous, etc.), all based on the belief that AA works and that its approach to healing and recovery from addiction is sound.
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But sometimes popularity breeds contempt. AA now has a giant target on its back, with detractors like Dr. Dodes coming from everywhere looking to take potshots. Part of the problem is that most AA participants have not been able to make their oaths of sobriety stick (as Dodes and Dodes take great pains to emphasize). Research suggests that only five to 10 percent of those who attend organizational meetings manage to keep their drinking at bay on a long-term basis. Needless to say this does not represent an astounding rate of success. Low success rates aren’t decisive evidence of anything, however. Even AA’s most vociferous critics admit overcoming a drinking problem is a mind-bendingly difficult task. It pushes people to the absolute limit and often requires them to overcome multiple instances of relapse. Recovery from alcohol addiction is grueling and intense because the disease itself is grueling and intense, and there is no easy way out regardless of the healing strategies addicts on the rebound choose to pursue. Nevertheless there are millions of recovering alcoholics who have left alcohol behind, seemingly for good, and many of these men and women rave about the influence of AA and swear they would not have been able to stay on the straight-and-narrow without it. Do these anecdotes not matter, simply because someone with a PhD has labeled AA’s methodology “bad science”?
Peers, sponsors and organizers in AA don’t sugarcoat the truth. They let newcomers know the path to recovery is fraught with pitfalls, temptations and daunting obstacles. But they also share information about what they know will work, if it is given the chance to do so. Studies show more than 80 percent of those who attend AA meetings will give up on the program in less than a year. This may signify it isn’t working for them, and that is the assumption many observers make. Of course it could also mean they haven’t hit rock bottom yet and still aren’t serious about their sobriety. Either way, it is clear AA can’t work properly if those who attend meetings don’t stick with it for an extended period.
But even if involvement in AA is brief, and doesn’t directly precede lasting recovery, who’s to say it can’t make a long-term contribution to the healing process? Sometimes addicts may need to hear the same hopeful/inspirational/instructional messages over and over again, until the wisdom behind the words finally sinks in. They may need to hear the testimony of dozens of people who’ve pulled themselves up from the depths of despair before it makes an impact. They may need to be confronted, frankly and honesty, a number of times over a multitude of years, before they’re ready to break through the walls of denial that have kept them using and abusing for far too long.
Could it be that strategies designed to help a person overcome alcohol addiction have to reach a critical mass before they take effect? If so we may need to reconsider the standards we use to evaluate AA. Letting AA Be AA AA has become so synonymous with recovery from alcoholism that many problem drinkers see it as a panacea, and that is a mistake. This attitude raises unrealistic expectations and puts a burden on the program it isn’t capable of handling. So if Dr. Dodes is simply confirming that involvement in Alcoholics Anonymous is not, in and of itself, enough to ensure recovery from a drinking problem, he is making a valuable contribution to the conversation.
But if that’s all that’s being claimed it hardly proves AA is useless or a waste of time. If we reimagine AA as a supplement to the long-term process of healing, our conception is altered and the program can be seen in the proper light – as a tool for recovery with real strengths and real limitations, all of which should be acknowledged and understood.
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